Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up

Valentina Agnese, Salvatore Pasta, Hector I Michelena, Chiara Minà, Giuseppe Maria Romano, Scipione Carerj, Concetta Zito, Joseph F. Maalouf, Thomas A. Foley, Giuseppe Raffa, Francesco Clemenza, Michele Pilato, D. Bellavia

Research output: Contribution to journalArticle

Abstract

Background: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV). Methods: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement. Results: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 ± 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001). Conclusions: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.

Original languageEnglish (US)
Pages (from-to)31-39
Number of pages9
JournalJournal of Molecular and Cellular Cardiology
Volume135
DOIs
StatePublished - Oct 1 2019

Fingerprint

Tricuspid Valve
Aorta
Dilatation
Aortic Valve
Aortic Valve Insufficiency
Thoracic Surgery
Aortic Aneurysm
Bicuspid Aortic Valve
Growth
Hypertension
Aortic Valve Stenosis
Dyslipidemias
Thoracic Aorta
Aneurysm
Coronary Artery Disease
Linear Models

Keywords

  • Aneurysm
  • Bicuspid aortic valve
  • Echocardiography
  • Repeated measures
  • Thoracic aorta

ASJC Scopus subject areas

  • Molecular Biology
  • Cardiology and Cardiovascular Medicine

Cite this

Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta : A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up. / Agnese, Valentina; Pasta, Salvatore; Michelena, Hector I; Minà, Chiara; Romano, Giuseppe Maria; Carerj, Scipione; Zito, Concetta; Maalouf, Joseph F.; Foley, Thomas A.; Raffa, Giuseppe; Clemenza, Francesco; Pilato, Michele; Bellavia, D.

In: Journal of Molecular and Cellular Cardiology, Vol. 135, 01.10.2019, p. 31-39.

Research output: Contribution to journalArticle

Agnese, Valentina ; Pasta, Salvatore ; Michelena, Hector I ; Minà, Chiara ; Romano, Giuseppe Maria ; Carerj, Scipione ; Zito, Concetta ; Maalouf, Joseph F. ; Foley, Thomas A. ; Raffa, Giuseppe ; Clemenza, Francesco ; Pilato, Michele ; Bellavia, D. / Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta : A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up. In: Journal of Molecular and Cellular Cardiology. 2019 ; Vol. 135. pp. 31-39.
@article{8eddc119e15f439f93248a4068f486c5,
title = "Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up",
abstract = "Background: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV). Methods: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50{\%}, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76{\%} of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement. Results: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 ± 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001). Conclusions: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.",
keywords = "Aneurysm, Bicuspid aortic valve, Echocardiography, Repeated measures, Thoracic aorta",
author = "Valentina Agnese and Salvatore Pasta and Michelena, {Hector I} and Chiara Min{\`a} and Romano, {Giuseppe Maria} and Scipione Carerj and Concetta Zito and Maalouf, {Joseph F.} and Foley, {Thomas A.} and Giuseppe Raffa and Francesco Clemenza and Michele Pilato and D. Bellavia",
year = "2019",
month = "10",
day = "1",
doi = "10.1016/j.yjmcc.2019.07.010",
language = "English (US)",
volume = "135",
pages = "31--39",
journal = "Journal of Molecular and Cellular Cardiology",
issn = "0022-2828",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta

T2 - A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up

AU - Agnese, Valentina

AU - Pasta, Salvatore

AU - Michelena, Hector I

AU - Minà, Chiara

AU - Romano, Giuseppe Maria

AU - Carerj, Scipione

AU - Zito, Concetta

AU - Maalouf, Joseph F.

AU - Foley, Thomas A.

AU - Raffa, Giuseppe

AU - Clemenza, Francesco

AU - Pilato, Michele

AU - Bellavia, D.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV). Methods: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement. Results: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 ± 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001). Conclusions: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.

AB - Background: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV). Methods: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement. Results: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 ± 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001). Conclusions: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.

KW - Aneurysm

KW - Bicuspid aortic valve

KW - Echocardiography

KW - Repeated measures

KW - Thoracic aorta

UR - http://www.scopus.com/inward/record.url?scp=85070340000&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85070340000&partnerID=8YFLogxK

U2 - 10.1016/j.yjmcc.2019.07.010

DO - 10.1016/j.yjmcc.2019.07.010

M3 - Article

C2 - 31348923

AN - SCOPUS:85070340000

VL - 135

SP - 31

EP - 39

JO - Journal of Molecular and Cellular Cardiology

JF - Journal of Molecular and Cellular Cardiology

SN - 0022-2828

ER -